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Question: This question is regarding not giving Narcan to a DNR patient. Obviously, if there is not an underlining medical issue (e.g. terminal CA) and a patient ODs, even with a DNR, we attempt to reverse any issues. However, if the patient does have a medical issue with a DNR, has decided to OD to commit suicide and is in a pre-arrest / arrested state, is it reasonable to assume that since they are breaking the law, that the DNR can no longer be valid?

Answer: Thanks for the question. Having a patient intentionally OD with a valid DNR would have to be an exceedingly rare event. Opioid antagonists (Naloxone) are specifically referenced on the DNR Confirmation Form as being contraindicated. If a patient has been found to have attempted suicide, the validity of the DNR form is not specifically addressed by the DNR Standard. In this rare situation, given the myriad of possible scenarios on scene (presence of family members, direction provided by substitute decision makers, condition of the patient, time to closest ED etc…) our recommendation is to patch to the BHP for direction in this unusual circumstance.